对臂丛阻滞患者应用不同剂量与浓度罗哌卡因的临床药效学观察

Effects of different doses and concentrations of ropivacaine in axillary brachial plexus block

目的观察新型酰胺类纯S型左旋式长效局麻药盐酸罗哌卡因在中国人患者腋路臂丛神经阻滞的临床药效动力学特征。方法选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级，年龄18～65岁，体重60～75kg，上肢肘及肘关节部以下神经、肌腱粘连松解、移位及功能重建手术患者200例，均在腋路臂丛阻滞下手术。根据罗哌卡因的剂量不同随机分为4组（组Ⅰ1．00mg／kg、组Ⅱ1．25mg／kg、组Ⅲ1．50mg／kg、组Ⅳ2．00mg／kg），每组50例，每组又依罗哌卡因的浓度不同分为5小组（0．15％、0．20％、0．25％、0．30％、0．35％），每小组10例。结果罗哌卡因对感觉、运动神经阻滞起效、完善和持续时间，组Ⅱ与组Ⅰ比较差异无统计学意义（P〉0．05），组Ⅲ、组Ⅳ与组Ⅰ比较差异有统计学意义（P〈0．05）；运动神经阻滞程度，组Ⅰ和组Ⅱ在注药后90min时肌力分别在M1和M2以下即感觉和运动神经阻滞呈分离现象，组Ⅲ和组Ⅳ在55min和27min达到M3和M4以上。结论罗哌卡因剂量在1．50～2．00mg／kg、浓度在0．30％～0．35％范围内腋路臂丛神经阻滞，可达到较完善的感觉和运动神经阻滞；剂量在1．25mg／kg，浓度在0．20％～0．25％范围内时感觉和运动神经阻滞起效、完善时间稍慢，持续时间稍短；剂量在1．00mg／kg、浓度为0．15％～0．20％时，感觉和运动神经阻滞起效时间、完善时间较慢，且止血带痛较多，仅能满足无需止血带的清创缝合术。

Objective To evaluate clinic pharmacodynamics of ropivacine hydrochloride, a new long-acting amide type local anaesthetic, in Chinese patients undergoing neurolysis and tendolysis of forearm through axillary brachial plexus block. Methods Two hundred ASAI-Ⅱ persons, aged 18 -65 ,weighing 60 - 75 kg, undergoing neurolysis and tendolysis of forearm under axillary brachial plexus block were randomly assigned to 4 equal groups to received ropivacine of the doses of 1.00 mg/kg （ Group Ⅰ ）, 1.25 mg/kg （ Group Ⅱ ）, 1.50 mg/kg （ Group Ⅲ ）, and 2. 00 mg/kg （ Group Ⅳ ）. Each group was subdivided into 5 equal subgroups according to the concentrations （0. 15%, 0.20%, 0.25%, 0. 30%, and 0. 35% ）. The effects were analyzed. Results There was no significant difference in starting time, consummating time, and persisting time of sensory and motor nerve block between Group Ⅰ and Group Ⅱ （ all P 〉 0. 05 ）. The starting time and consummating time of Group In and Group Ⅳ were all significantly shorter than those of Group Ⅰ （ all P 〈 0. 05 ）, and the persisting times of Groups In and Ⅳ were all significantly longer than those of Group Ⅰ （P 〈 0. 05）. 90 minutes after brachial plexus block the degrees of muscle strength Groups Ⅰ and Ⅱ were M1 and M2 respectively, hence, the sensory and motor nerves block was in dissociation. When motor never block was above M3 and M4 the interval of brachial plexus block was 55 rain and 27 min in Group In and Groupiv respectively. Conclusion Sensory and motor never can be blocked perfectly when the dose of ropivacaine is between 1.5 mg/kg and 2. 0 mg/kg and the concentration is between 0. 30% - 0. 35%. When the doses of ropivacaine is 1.25 mg/kg and the concentration is0. 20% -0. 25% the starting and consummating time are longer and persisting time is shorter. When the doses of ropivacaine is 1.00 mg/kg and the concentration is 0. 15% - 0. 20% the starting and consummating time are longer and only satisfies external debfidement and suture without tourniquets.